SURGICAL SERVICES Center for Bone and Joint Health

HIP REPLACEMENT PATIENT GUIDE Hip Replacement Guide Table of Contents

The Joint Replacement Program at Hunterdon Medical Center...... 2

Preparing for Surgery Important Dates to Remember...... 3 Having Support ...... 4 Pre-operative Education Class ...... 5 Pre-admission Testing Center...... 6 Medication Review ...... 7 Maximizing Your Surgical Outcome ...... 9 Home Preparation and Safety Checklist...... 11 Packing for the Hospital...... 12 Day Before Surgery...... 13

Your Hospital Stay What to Expect at the Hospital ...... 15 Understanding Your Surgery...... 17 Hip Replacement Overview ...... 18 After Your Surgery...... 20 During Your Stay ...... 21 Preventing Complications ...... 24 Total Hip Precautions ...... 25 Rehabilitation ...... 26 Planning Your Discharge...... 33

Returning Home Your Road to Recovery...... 35 Blood Clot Prevention After Joint Replacement ...... 39 Blood Thinning Medication...... 40 Long-term Care of Your Joint Replacement...... 41

Exercises Pre- and Post-op Exercises...... 42

Physicians & Resources Our Physicians ...... 47 Resources ...... 50

The Center for Bone and Joint Health at Hunterdon Medical Center www.hunterdonhealthcare.org

Welcome to Hunterdon Medical Center’s Joint Replacement Program!

This book is designed to take you through the process of having your hip replacement surgery. I will facilitate your care and provide you with education about what you can expect at every stage of your hip replacement journey. The staff and I want you to have the best possible experience at the Center for Bone and Joint Health.

I will be available to meet your needs along the way. I work with a team of skilled physicians, nurses, therapists and support staff who have put every effort into making your experience a seamless process. We consider ourselves partners in your care and recovery and know that together we can make your time with us a positive experience.

Please schedule yourself for one of our pre-operative education classes, a schedule of dates and times for these classes is provided by the surgeon’s office. Attending this class is the first step in preparing yourself for surgery. In the meantime, please call me if there is any way I can be of assistance. I welcome your feedback about your experience as we continue to strive to improve our Joint Replacement Program.

Thank you for choosing us to be your partners in care!

Sarah Brenly Sarah Brenly RN, MSN, ONC Program Coordinator The Center for Bone and Joint Health Hunterdon Medical Center 908-788-6423 (office) 908-328-9119 (cell)

Your full circle of care. Center for Bone and Joint Health Joint Replacement Program at Hunterdon Medical Center

The Hunterdon Medical Center Our team of surgeons is Board staff is the leader in the provi- Certified and Fellowship sion of quality, compassionate Trained in Orthopedics. We and effective healthcare. We have one of the lowest infection have achieved this recognition and complication rates in the state through teamwork, personal initia- of New Jersey. We have renovated our tive and continuous innovation. We have operating facilities, including construction built lifetime relationships with the citizens of of two new, fully equipped, state-of-the-art our community based on anticipation of operating rooms specifically designed for needs and exceeding the joint replacement. expectations of those we serve. In 2017, Hunterdon Medical Center received Hunterdon Medical Center is a Magnet the Women’s Choice Award for America’s hospital designated from the American Best Hospitals for Orthopedics. This award is Nurse’s Credentialing Center. Only about 5 given to full service hospitals that provide percent of the hospitals in the United States comprehensive orthopedic services including have achieved Magnet status. Being a Magnet post-operative recovery instructions and have a hospital means our nurses deliver excellent low surgical complication and infection rates in patient outcomes and they have a high level addition to high patient satisfaction scores. of job satisfaction. Our nursing leaders value staff nurses and involve them in research-based The staff at Hunterdon Medical Center is nursing practices. Magnet hospitals have open part of the community it serves. Personal communication between nurses and other pride is taken in caring for friends, family members of the health care team. Our staff and neighbors. The greatest compliment you members appreciate and respect each other. can pay us is to return to us if you have future needs or to refer others to our facility.

2 The Center for Bone and Joint Health at Hunterdon Medical Center Important Dates to Remember

Patient Last Name______First Name ______DOB ______Phone______Alternative Contact ______Date of Surgery______Surgeon Name ______Scheduled Procedure: Total Hip ______Total Knee ______Right ______Left ______Bilateral ______Revision ______Surgical Scheduler ______Phone 908-782-0600 Ext ______

Surgical Scheduling Date ______Time ______8100 Wescott Drive, Suite 201, Flemington, NJ (enter through upper level).

Pre-admission Testing – Ambulatory Testing Center (ATC) 908-788-6666 Date______Time ______Report to Admitting on 1st floor of Hunterdon Medical Center, 2100 Wescott Drive, Flemington to register. You will then be directed to ATC on the 2nd floor (located in radiology).

Pre-operative Orientation Class Review the class schedule and call to schedule your class at 908-788-6423. For directions, please refer to the class schedule you were given. Date ______Time ______Pre-op Appointment Date______Time______Flemington/Bridgewater

Pre-operative Appointments Please note: It is your responsibility to make sure all pre-operative testing and clearances are done PRIOR to your pre-operative appointment with your surgeon. ______NAME DATE TIME ______NAME DATE TIME ______NAME DATE TIME ______NAME DATE TIME

Post-operative Appointment Date______Time______Flemington/Bridgewater Date______Time______Flemington/Bridgewater

The Center for Bone and Joint Health at Hunterdon Medical Center 3 Having Support

Our team of dedicated professionals will provide you with the care and education you will need for preparing for surgery all the way through to a return to a more active life. Your experience will be enhanced by having your family and/or friends support you.

We welcome and encourage you to have someone support you. It may be more than one person but it’s important they feel confident about the care you will need and to find out how they can best support you.

Your support person(s) are welcomed to attend the pre-operative education class, visit you in the hospital and participate in your therapy sessions here and as you continue with therapy once you are discharged. This is the best way for you to both feel confident!

We strongly recommend you have a responsible adult at home for a minimum of three days after discharge.

All Joint Replacement surgeries are performed at Hunterdon Medical Center 2100 Wescott Drive, Flemington, NJ 08822 908-788-6100

4 The Center for Bone and Joint Health at Hunterdon Medical Center Pre-operative Education Class

It is essential you schedule a Pre-operative Education Class prior to surgery. Bring a support person along with you as they may have questions and will feel more confident about how they can help you after surgery.

At This Session: • You will learn about your total joint experience from start to finish • You will learn how the people who support you can facilitate your recovery

We Will Review the Following: • How to prepare for surgery • What to bring to the hospital • How to control risk factors • What is Hip Replacement Surgery? • How you will manage pain • How to prevent complications • Discharge options • Getting back to life with a new joint and improved mobility

There will be a slide show and discussion of all aspects of care including a demonstration of pre-op exercises. Maintaining mobility will be the key to your success!

Come to the class with a list of questions or concerns. We want you to feel confident about your procedure and aftercare. Bring this book.

If you are unable to attend the pre-operative education class in person OR you and the people who support you would like to review the class content, it is available online: www.centerforjointhealth.com Click on the blue bar labeled JOINT REPLACEMENT OVERVIEW There are 5 short modules to review

The Center for Bone and Joint Health at Hunterdon Medical Center 5 Pre-admission Testing Center

Pre-admission testing takes place in the Ambulatory Testing Center.

Hours: 7am – 5pm, Monday through Friday (excluding major holidays) Location: Hunterdon Medical Center (2nd Floor) Phone: 908-788-6666

You Will Need to Bring: • A list of all of your current medications and doses, including over-the-counter medications and herbal medications. Use page 9 to write down all the medication you take including the dose and number of times a day you take each medication to make sure it is accurate. • A list of all previous surgeries and information about your medical history • Copies of advanced directives (living will and durable power of attorney) if you have them • Insurance cards (all that may apply) • Identification card • Insurance co-payment • Joint replacement patient binder • Blood work, chest x-rays, EKG, or other test results. If you have access to these and they were done at another facility, please bring the information with you.

6 The Center for Bone and Joint Health at Hunterdon Medical Center Medication Review

Please write down all of your current medications on the form on both sides of this page. Bring it with you to your pre-admission testing appointment.

Name

Address

Phone Date

Drug Allergies

In Case of Emergency Call:

Relationship Home Phone

Work Phone

Insurance Company Policy#

Phone

Medicare#: Phone

PNEUMOCOOCAL (dates):

ZOSTERVAX (dates):

TETANUS (dates):

INFLUENZA (dates):

Pharmacist Phone

Pharmacist Phone

Doctor Phone

Doctor Phone

Doctor Phone

The Center for Bone and Joint Health at Hunterdon Medical Center 7 Medication Review

Prescription Medicine Name Strength Number of Times Reason for Taken Each Day Taking

Non-Prescription Medicine Name Strength Number of Times Reason for Taken Each Day Taking

8 The Center for Bone and Joint Health at Hunterdon Medical Center Maximizing Your Surgical Outcome

Every surgical operation has potential risks. The most common risks of hip replacement surgery include: • Wound infection • Blood clots in the legs – also called deep vein thrombosis (DVT) • Pulmonary embolus – when a blood clot travels from your legs to your lungs. • Urine infection – if you cannot urinate after surgery, sometimes a catheter is placed in your bladder. This can sometimes cause an infection. • Lung problems – including pneumonia • Bleeding – sometimes requires a blood transfusion • Injury to nerves that are located near the hip, usually from swelling or bleeding. Sometimes this will cause numbness or weakness. • Skin blisters from swelling.

The entire focus of our joint replacement program is to minimize the risk of complications and to maximize your successful outcome. These are things you can do before surgery to ensure the best result:

Healthy Eating • Eat healthy, well-balanced meals, emphasizing fruits, vegetables and whole grains and minimizing saturated fats. • Tell your surgeon if you have been following a physician-prescribed diet before hospitalization. • If you are diabetic, it is important to check your glucose (sugar) levels and follow the diet recommended by your physician.

Breathing Exercises Exercising your lungs is the best way to prevent complications like pneumonia. We rarely think about how we are breathing but this is the perfect time to start. • You will be given an Incentive Spirometer when you arrive at the Same Day Center on the day of surgery. Practice using it to make sure you are familiar with it and you know your baseline. • Practice deep breathing exercises by taking a deep breath through your nose and holding it for 5 to 10 seconds. Exhale slowly through your mouth. Repeat five times.

The Center for Bone and Joint Health at Hunterdon Medical Center 9 Maximizing Your Surgical Outcome

Weight Loss • Body Mass Index (BMI) is a calculation that takes into account your height and weight. Your physician can calculate this for you. • If your BMI is 35 or greater, your risk of infection or a blood clot is five times higher than if it is less than 35. We strongly urge you to lose weight before hip replacement surgery to minimize these risks.

Dental Health • Inspect your teeth for any loose teeth or painful gums. If you have either, please consult your dentist before surgery. Problems with your teeth can cause complications during surgery and long-term concerns for patients with hip and knee replacements. • Your anesthesiologist will want to know about any dental prostheses (false teeth, bridges, and implants), tooth or gum disease, or cosmetic dentistry. This information is needed because of the risk of trauma or damage to teeth during the insertion of breathing tubes or other instruments.

Prostate Health • In men, prostate problems can cause problems with urinating after surgery. If you have prostate problems that are not well controlled with medications, please see your physician about treatment prior to surgery.

Smoking Cessation Hunterdon Medical Center is Tobacco Free, which means tobacco use of any kind is prohibited indoors or 25 feet from any entrance. • If you smoke or use smokeless tobacco, we strongly encourage you to stop. Smoking adversely affects bone health and can limit the success of your hip replacement. • Ask your nurse or doctor if assistance is needed to stop smoking. If you are interested in more information about how to quit smoking, please refer to the resources under Information to Help You Quit Smoking on page 51 of this book.

Exercises (The most important thing you can do is to be active...exercise) • Prior to surgery, it is important for you to strengthen your muscles because they may have become weak due to arthritis and decreased activity. Refer to the Exercises section of this book. Performing these exercises before surgery will improve your muscle strength and help you become more familiar with the exercises you will do following surgery.

10 The Center for Bone and Joint Health at Hunterdon Medical Center Home Preparation and Safety Checklist

Here are some items and home modifications that will help you prepare for your return from the hospital. Please let us know if you have questions or concerns about these suggestions.

Remove all throw rugs or make sure they have non-skid backing applied. Make sure walkway areas are well lit and free of clutter so you can pass easily with a walker. This may require a temporary rearrangement of furniture. Consider getting a bag or basket to attach to your walker to carry small items, and a portable phone with you at all times with a list of emergency numbers. Measure your bed height. It should be 1 or 2 inches above the bend in your knee. A firm mattress is recommended. Be sure the height of your toilet is 1 or 2 inches above the bend in your knee. There is equipment to use during recovery if this is not the case. Use a hand-held flexible shower head, if possible. Install rubber mats or safety strips in the bathtub/shower. Have a mat or other non-skid surface to step on when getting out of the tub/shower Keep a flashlight nearby for emergencies.

Find a stable chair with armrests, a firm seat and NO WHEELS. The seat height should be 1 or 2 inches above the level of your knee. A recliner or armchair with ottoman (footstool) will allow you to elevate your feet. This will limit post-op swelling. Place a cushion or folded blanket in chairs that sit low or are hard to get out of OR consider bed/chair risers that elevate the sitting height. Consider stocking your freezer with meals prepared before surgery or buying frozen meals. Move frequently used items to waist height for easy retrieval – medications, phone, cooking items or anything that is stored high or low that you may need. A small, wheeled cart can work well in the kitchen Plan to have someone stay with you the first three nights and someone available to help with tasks such as shopping and housekeeping for several weeks. Have a cold gel pack available to use after therapy or intermittently on your incision to help control pain and swelling. If feasible, have at least one sturdy handrail for stairs. Try to arrange for a mid-size, easily accessible vehicle to take you home. You may not be able to step into a truck, and compact cars may not allow you the space to enter comfortably. Record the number of stairs to enter home ____ and the number of stairs to get to bedroom_____. We will need to know this information when making discharge plans. If your bedroom is upstairs you will likely be able to manage stairs when you return home. Write any concerns you have down to discuss with therapist after surgery. Consider your pets and their needs prior to surgery. You may need help with feeding or walking them for the first few weeks after surgery.

The Center for Bone and Joint Health at Hunterdon Medical Center 11 Packing for the Hospital

What to Bring: • YOUR PATIENT EDUCATION BOOK • Sweat pants or shorts with elastic waist work best after hip replacement • Supportive footwear with backs such as sneakers/tennis shoes (loose in case your feet swell post-operatively) • Toiletries for your stay: toothbrush, toothpaste, shaver, comb, deodorant, denture and contact lens supplies as appropriate • Glasses if you wear them • Books, magazines or craft projects to help pass the time between therapies • CPAP or BiPAP machine if you use one at home • List of your current medications and dosages. Be sure to note the last date and time each was taken

What NOT to Bring: • Large amounts of money or credit cards • Jewelry – For your safety, jewelry and body piercings will be removed prior to surgery • Medications – unless you were specifically instructed to bring the medicine • Your own walker, cane or crutches – we will provide you with this equipment to use during your stay – we do not want your equipment to be misplaced

12 The Center for Bone and Joint Health at Hunterdon Medical Center Day Before Surgery

You will be contacted by the surgeon’s office the day before surgery (or on Friday if you are scheduled for Monday) and told what time to arrive at the hospital. • There are certain medications you must take the day of surgery with water. You will be advised during your Ambulatory Testing appointment. If you have any questions about which medication you should or should not take call the staff at Ambulatory Testing 908-788-6666. • Food and drink taken before anesthesia can cause problems such as choking and vomiting. There are a few rules about eating and drinking to help minimize these problems. If you have diabetes, gastric reflux, hiatal hernia or any disease of your stomach, do NOT eat any food or drink any liquids for 8 hours before you are told to arrive at the hospital.

8 HOURS b efore the time you are told to Stop all foods and liquid (other than the arrive at the hospital. clear liquids listed below)

You may continue to drink CLEAR LIQUIDS Clear Liquids means liquid you can see until 2 HOURS before you were told to through. Examples are water, apple juice or arrive at the hospital for surgery other clear juice without pulp, plain jello, tea or black coffee. NO MILK OR ALCOHOL.

• Remember to Shower – You will take 2 showers. One the night before surgery and another the morning of the surgery. Shower with Chlorhexidine provided by the Ambulatory Testing Center. It will reduce bacteria on the skin that can cause infection.

Pre-operative Showering Instructions We are very interested in keeping you safe and free of infection. Studies show that bathing with an antibacterial soap prior to surgery reduces the risk of post-operative infection and shaving increases that risk.

We recommend that you shower with antibacterial (chlorhexidine) soap the evening before your surgery and again the morning of surgery. You will be given a 4-ounce bottle of antibacterial soap at the time of your Pre-admission Testing appointment.

Please do not shave the surgical area within 72 hours prior to surgery and do not put any creams or oils on your skin after your antibacterial soap showers.

The Center for Bone and Joint Health at Hunterdon Medical Center 13 Day Before Surgery

Directions for Your Shower: • Thoroughly rinse your body with water from the neck down. Apply a thin layer of the antibacterial soap solution to your skin from the neck down, using one-half of the bottle provided; allow the product to remain on your skin for about 2 minutes. Then wash your skin gently, avoiding contact with the genital area and open wounds (superficial skin wounds are not a problem). Do not use in eyes, ears or mouth. Rinse thoroughly. Pat dry with a clean towel. • Wear clean nightclothes. • On the morning of your surgery, shower as above with the remaining antibacterial soap. • Put on clean clothes and report to the hospital.

14 The Center for Bone and Joint Health at Hunterdon Medical Center What to Expect at the Hospital

Day of Surgery • Report to the SAME DAY CENTER at Hunterdon Medical Center on the second floor at your scheduled time. You will arrive at the hospital approximately two hours prior to the time your procedure is scheduled. Lateness can result in postponements or cancellations in some cases. • We will prepare you for surgery and answer any questions you may have. • Feel free to bring items that can help you pass the time. • Remember to Take a Second Shower –In the morning, shower AGAIN with the Chlorhexidine soap. • You will be prepared for surgery and all parts of the process will be explained to you. • You will be asked several questions to verify the information we have is correct. • Your vital signs (blood pressure, heart rate, oxygen saturation, temperature and level of pain) will also be recorded. • An intravenous (IV) catheter will be placed in one of your veins to allow fluid and medications to be given to you during and after surgery. • Pre-op medications as prescribed by your physician will be administered at this time. • Your belongings will be safely transported to your room on 5 North.

Anesthesia for Joint Replacement You will meet your anesthesiologist before surgery and be given a chance to discuss your anesthetic plan and ask questions. Your anesthesiologist will review all information needed to evaluate your general health.

We use general anesthesia for hip replacement surgery. With general anesthesia you are put completely to sleep and your breathing will be supported with a breathing tube. A machine will be used to breathe for you. Your vital signs will be closely monitored during surgery.

Just like other medical procedures, there are potential risks associated with any anesthetic. Serious complications are extremely rare. Your anesthesiologist will discuss with you the risks and benefits of anesthesia.

The Center for Bone and Joint Health at Hunterdon Medical Center 15 What to Expect at the Hospital

3M Skin and Nasal Antiseptic Thirty percent of people carry bacteria in their nose called Staphylococcus aureus, often referred to as “Staph” or “Staph aureus.” People who carry Staph aureus in their nose are at higher risk of developing infections from these bacteria. That is why your doctor has ordered you to have 3M™ Skin and Nasal Antiseptic Patient Preoperative Skin Preparation to your nose before surgery. Applying the antiseptic one hour before surgery reduces the bacteria in the nose and may reduce the risk of infection after surgery.

What Can I Expect When I Apply the Product? • A slight smell or taste during the application which will not last long. • The majority of people rate the overall acceptability as acceptable or very acceptable. • The applicator swab is designed to fit comfortably in the nose. • The thickened formula helps make the application easy. • If a small amount drips out of the nose during application, it can be easily wiped away. • It will not stain the skin. • The antiseptic must remain in contact with the nasal tissue. • Do not blow your nose or wipe the nostrils.

What if I am Allergic to Iodine? True allery to iodine does not exist. Do not use if you have a known sensitivity to iodine or any other ingredient in this product. Talk to your healthcare provider about all your allergies.

16 The Center for Bone and Joint Health at Hunterdon Medical Center Understanding Your Surgery Disease Processes

Osteoarthrosis (also called Osteoarthritis) • Osteoarthrosis is a degenerative joint disease that affects the cartilage surface on the ends of the bones. • The cartilage becomes worn, no longer allowing smooth movement inside the joint. • The worn cartilage surface can cause inflammation on the joint tissues. • Pain, stiffness, swelling and loss of function are common as the cartilage continues to wear away and inflammation worsens. • The wear may occur on one side of the joint more than the other, which can cause progressive joint deformity.

Rheumatoid Arthritis • Rheumatoid arthritis is a systemic autoimmune disease that causes chronic inflammation of the joints. • It causes swelling, pain, stiffness and redness in the joints and other tissues around the joints. • Chronic inflammation can lead to destruction of the cartilage, bone, tendons, and ligaments, which may cause progressive joint deformity.

The Center for Bone and Joint Health at Hunterdon Medical Center 17 Hip Replacement Overview

The hip is one of the largest weight-bearing joints in the body. The hip is a very stable ball-and- socket joint: A ball (femoral head) at the top of the thigh bone (femur) fits into a rounded socket or cup-like cavity (acetabulum) in your pelvis. The femoral head is attached to the rest of the femur by a short section of bone called the femoral neck. A large bump, call the greater trochanter, juts out from the top of the femur, next to the femoral neck. Bands of tissues called ligaments form a capsule connecting the ball to the socket and holding the bones in place.

A layer of smooth tissue called cartilage cushions the surface of the bones, helping the ball to rotate easily in the socket. Fluid-filled sacs (bursae) cushion the area where muscles or tendons glide across bone. The capsule surrounding the joint also has a lining (synovium) that secretes a clear liquid called synovial fluid. This fluid lubricates the joint, further reducing friction and making movement easier.

Hip replacement surgery replaces the worn cartilage surface with an artificial surface called a joint prosthesis. These prostheses are made of metal, plastic, or ceramic. The prostheses have a rough surface, which the bone grows into, providing a secure attachment without cement.

18 The Center for Bone and Joint Health at Hunterdon Medical Center Hip Replacement Overview

Types of Hip Replacement Your orthopedic surgeon will help you to select the type of replacement that is best for you and your condition, based on your joint anatomy, age, weight and future activity level. • Total hip replacement – a metal shell is inserted into the acetabulum, and the articulating bearing surface is placed into the shell. A prosthesis stem is inserted into the femur and the head is then placed on the stem. The head and the bearing surface of the shell can be different materials. – Metal head/plastic (polyethylene) bearing – Ceramic head/plastic bearing – Ceramic head/ceramic bearing • Hemiarthroplasty of the hip – only the femur prosthesis is used. Your socket is left alone. • Hip resurfacing – a cap is attached to the top of the femur to resurface the head rather than the stemmed prosthesis being inserted. The metal shell that is inserted into the acetabulum is the same as the one used in total hip replacement.

The Center for Bone and Joint Health at Hunterdon Medical Center 19 After Your Surgery

Post Anesthesia Care Unit (Recovery Room) Your surgery will last 1 to 3 hours. Afterwards, you will awaken from anesthesia in the operating room and be transferred to the Post Anesthesia Care Unit (PACU). You may not remember much until you reach the recovery room.

• You will awaken in the PACU wearing an oxygen mask. Nurses will monitor your level of pain and your vital signs. • You will receive medication for pain and nausea as needed. • You will have a sequential compression device (SCD) on each calf, which will alternate squeezing and releasing pressure on your legs to reduce the risk of blood clots. • There will be a surgical dressing over your incision. • You may have a catheter in your bladder. • Your surgeon will talk to your family in the waiting room and answer their questions. Family members may visit you when you arrive at the 5 North Joint Replacement Unit from the PACU. • You will remain in the PACU until your vital signs are stable, your pain is well controlled and you are awake and alert. This is usually 1 to 2 hours.

Your Stay on 5 NORTH 5 North is our post-operative care area where all of your needs will be addressed. Our team of registered nurses and patient care assistants has been specially trained to care for patients after joint replacement. Physical therapy will take place in an area near your room or in the hospital’s larger therapy treatment room.

During Your First Day Our Goals for You Will be to: • Meet your care team • Get out of bed to a chair with assistance • Perform ankle pumps and thigh muscle tightening exercises • Take deep breaths and cough • Perform your incentive spirometer exercises to encourage deep breathing • Manage your pain • Drink beverages and eat foods that you can tolerate and that seem appetizing.

20 The Center for Bone and Joint Health at Hunterdon Medical Center During Your Stay

Managing Your Pain Starting your rehabilitation exercises as soon as possible is the single most important factor in having an optimal outcome with the lowest risk of complications. You cannot accomplish this unless your post-operative pain is well controlled. Some pain is expected, but we have many ways to minimize it. • We utilize a combination of pain medications, determined by your surgeon as being appropriate for you, to control your pain. • We try to avoid giving you pain medicine by injection because there is a greater chance of nausea with injections versus pills. • Sometimes surgeons use a combination of medications that are injected around your wound during surgery. The goal is to reduce surgical pain in the soft tissues (muscles and ligaments) for a period of time after surgery. • We use a Pain Rating scale that enables patients to rate their pain from 0-10. • We will ask you frequently to rate your pain, especially before and after you are given pain medication.

The Center for Bone and Joint Health at Hunterdon Medical Center 21 During Your Stay

• We provide cold therapy in the form of cold packs to your operative hip. This will help reduce swelling and pain after activity. • Being mobile is helpful in reducing pain. • Taking pain medicine about 30-60 minutes prior to your scheduled therapy time will help control your pain and help to make the best of your therapy sessions. • Do not wait until your pain is severe before asking for pain medications.

Preventing Nausea Unfortunately, anesthesia and pain medication can cause nausea and vomiting as a side effect. • Our anesthesiologists carefully adjust the medications during your surgery to minimize nausea. • You will be given medication to reduce the effects of nausea for 24 hours after surgery. • If you are having symptoms of nausea, your nurse will continue to provide you with IV fluids until these symptoms pass. • Getting out of bed to a chair and starting to walk on the day of surgery is the single most effective way to minimize nausea.

Patient walking Avoiding Constipation Anesthesia, narcotic pain medications and immobility can decrease bowel function after surgery. To help lessen the chance of constipation we use the following: • Early mobilization – getting you up to a chair and walking as often as possible. • Stool softeners will be given twice daily as prevention. • Additional laxatives will be used as needed.

22 The Center for Bone and Joint Health at Hunterdon Medical Center During Your Stay

Minimizing Swelling Swelling around the hip and in the leg is normal after surgery. To minimize this: • Be mobile. Walking is the best prevention. • Ice is often used around the hip, especially after therapy sessions. • Continue doing your ankle pumps. This is the most important exercise to decrease swelling and prevent bood clots. • Swelling around the hip may put pressure on the nerves that run down your leg. If you feel numbness or tingling anywhere in the leg, tell your nurse as soon as possible.

Minimizing Bleeding • During surgery and after surgery your surgeon may use a medication called Tranexamic Acid. This medication is used to decrease bleeding. • Please let us know if you are color blind. If you are then you should not receive this medication.

The Center for Bone and Joint Health at Hunterdon Medical Center 23 Preventing Complications

As with any surgery, complications may occur. The following highlights the most common ones and the things we do to help prevent them:

Pneumonia • Early mobilization: Up to a chair and walking as soon as possible • Use your incentive spirometer: Take 10 deep breaths once every hour you are awake.

Blood Clots (Deep Vein Thrombosis or DVTs) and Pulmonary Embolus • Anticoagulation therapy (blood thinners): You will be given Aspirin or Warfarin (Coumadin) to use for 4 weeks after surgery. • Sequential Compression Devices (SCDs): These squeeze your calves and encourage blood flow. • Leg exercises: While you are awake, you should perform your ankle pumps 10 repetitions every 15 minutes. • Early mobilization: You will get up and walk with the walker to the bathroom with assistance within the first 24 hours after surgery. • If you already take an anticoagulant your treatment will be determined by your surgeon and the physician who prescribes your medication for you.

Infection • Most patients will have an AquaCel Dressing in place over their incision. – This dressing is water-proof and can be worn in the shower and pat dry. – It is intended to protect your incision from bacteria that can cause infection. – It is not to be lifted up until it is being removed because it will not re-stick to your skin. – It should be left in place for ONE WEEK or until the day your staples are removed if longer than one week. – If it needs to be removed for any reason before that time, you may cover your incision with a clean, dry gauze. • Antibiotics that help your body fight infection are given just before surgery and for 24 hours afterward. • All staff members use hand sanitizer as they enter and leave patient’s rooms. • Encourage your visitors to use the hand sanitizer as they enter and leave your room. • You should use hand sanitizer or wash your hands frequently.

24 The Center for Bone and Joint Health at Hunterdon Medical Center Total Hip Precautions

While very rare, there is a risk for hip dislocation after hip replacement surgery. You will need to adhere to some precautions during the first few months after surgery.

1. Do not bend your operated hip beyond a 90˚ angle. 2. Do not turn your operated leg inward in a pigeon-toed position. 3. Do not cross your operated leg or ankle.

This section provides reminders about proper positions when sitting, standing and lying down. Let your therapist or your doctor know if you have questions about these precautions.

1. Maintain greater than 90˚ angle 2. No pigeon toe 3. No crossing operated leg/ankle

Do not bend down at the waist Do not twist your (use a reacher) torso inward

The Center for Bone and Joint Health at Hunterdon Medical Center 25 Rehabilitation

Rehabilitation While in the Hospital Our rehabilitation team will work with you to improve your functional abilities. • Physical Therapy staff will assist you with exercises, walking with a walker, and stair climbing. • Occupational Therapy staff will instruct you on tub/car transfers, self-care activities, and use of adaptive equipment like sock aids and reachers

Your motivation and participation in the therapy program are important to the speed and success of your long-range rehabilitation, as well as getting you ready to go home. This means you are the greatest factor in a successful recovery.

Your rehabilitation goals for discharge are simple: • Maximize your joint strength and range of motion. • Get in and out of bed and a chair safely. • Walk safely with an assistive device as determined by the therapy staff. • Dress yourself using adaptive equipment if needed. • Go up and down stairs safely (with or without assistive devices).

Activities of Daily Living Before you leave the hospital, you must meet the goals set by your Physical and Occupational therapists. They will prepare you for activities of daily living and instruct you on the best ways to move about. The following pages/illustrations will help you maintain your hip precautions when you go home.

26 The Center for Bone and Joint Health at Hunterdon Medical Center Rehabilitation

Standing • Move your operated leg forward and push off the arm rests of the chair to stand up. • Once you have your balance, reach for the walker.

Sitting • Sit in raised seats (2 pillows) or on a raised toiletseat/commode with armrests. • Reach back for the arm rests of the chair with both hands. Bring the operated leg forward and slowly lower into the chair or raised toilet seat/commode. • Do not lean forward. Your shoulders should stay behind your hips. • Do not raise your knee higher than your hip while sitting. Sit with the operated leg forward.

Using a Walker to Begin Walking, be sure to • Move the walker first. • Then, move the operated leg forward. • Push down on your hands when you step forward with your non-operated leg. • Do not turn (pivot) on your operated leg. Instead, pick up your feet and turn using several small steps.

The Center for Bone and Joint Health at Hunterdon Medical Center 27 Rehabilitation

Dressing Your occupational therapist will instruct you in the use of adaptive equipment to assist you with dressing within your hip precautions. Items you may need include: a sock aide (seen above), reacher, leg lifter, long handled shoe-horn, elastic shoe laces, and long handled sponge.

Tips to remember when getting dressed: • Avoid bending forward when putting on pants, socks and shoes. • Do not cross your legs when putting on pants, socks and shoes. • Putting on your pants: Using a reacher or dressing stick, put the operated leg into the pant leg first. Then put the non-operated leg into the other pants leg. • Removing your pants: Using a reacher or dressing stick, remove the non-operated leg from the pant leg first. Then, remove the operated leg from the other pant leg. • Keep your back touching the back of the chair. • Tying your shoes: Use elastic shoelaces or sturdy slip-on shoes with heel support.

Homemaking • Sit for rest breaks as needed. • Slide objects along the countertop rather than carrying them. Use a utility cart with wheels to transfer items to and from the table. • Attach a bag or basket to your walker or wear a fanny pack to carry small items. • Use a long-handled reacher ("grabber”, “pick-up stick”) to reach objects on the floor. • Remove all throw rugs and long electrical cords to avoid tripping in your home. • Watch out for slippery/wet areas on the floor.

28 The Center for Bone and Joint Health at Hunterdon Medical Center Rehabilitation

Lying In Bed • Lie on your back with a pillow wedge or 2 pillows between your knees. Do not allow your operated leg to cross the middle of your body. • You may lie on your operated side with the pillow wedge or with 2 or more pillows between your legs at the knees and ankles to prevent crossing your legs.

Getting Out of Bed • Slide your legs toward the edge of the bed, keeping operated leg with knee straight and toes pointed up. • Push up onto your forearms. • Push up onto your hands. • Slide legs so your heels are over the edge of the bed. • Scoot your hips forward until both feet are on the ground.

Getting Into Bed • Sit on the edge of the bed with both feet on the ground. Make sure you are not bending forward and that your operated hip is not turning in. • Once seated, angle you bottom towards the pillow using your hands. • Bearing weight on your hands, scoot your hips backward onto the bed. Keep your shoulders back. • Lower yourself onto your forearms. • Carefully slide your legs onto the bed, keeping operated leg with knee straight and toes pointed up.

The Center for Bone and Joint Health at Hunterdon Medical Center 29 Rehabilitation

Bathing or Showering You may shower when approved by your doctor. You and your occupational therapist will discuss the correct technique to step into your shower stall or bathtub at home. The technique will depend on your home environment and functional abilities on discharge, however a shower chair is typically recommended.

Bathing Tips: If able, some people choose to install a hand held shower hose, which enables you to bathe below your waist with increased ease. • If you do not have non-skid strips glued to the floor of your shower stall or bathtub, carefully place a non-skid rubber bath mat on the floor of the stall/tub. • Do not sit on the bottom of the bathtub to bathe during the time you are following hip precautions. • Use liquid soap to minimize risk of dropping a bar of soap and flexing hip to retrieve it off the floor while showering. • A long-handled bath sponge will help in bathing below the knees

30 The Center for Bone and Joint Health at Hunterdon Medical Center Rehabilitation

Using a shower chair: In some cases, patients may use a shower chair for a short period of time after surgery. Ensure proper height of chair. Using the walker, walk to the side of the tub. Turn so that you are facing away from the tub. Reach back with one hand for the back of the chair. Sit down on the chair, keeping the operated leg straight out. Lift legs one at a time over the tub and turn to face the faucet. When getting out, lift each of your legs over tub, push up from the chair, and stand up outside of the tub. The leg lifter may be helpful to assist with lifting the operated leg if needed.

Insurance does not cover these items. They can be purchased online at retail pharmacies or local medical supply stores.

If you utilize a shower stall, the 3-1 commode (that is covered by most insurances) can also be utilized in the shower stall as a seat. Simply have a friend/family member remove the bucket and Tub bench- extends over the edge place inside. Typically 3-1 of the tub Adjustable shower chair with commodes do not fit inside tubs. back. Can be placed in tub or shower stall 3-1 commode uses: 1.) Over toilet, 2.) Inside shower 3.) With the bucket inside and commode placed at the bedside or another location as needed.

3-1 commode

The Center for Bone and Joint Health at Hunterdon Medical Center 31 Rehabilitation

Getting Into a Car • Recline the seat back as far as possible. • With your walker in front of you, slowly back up to the car seat. • Sit on the car seat. • Angle bottom towards back of chair using your arms. • Swing your legs into the car. Lean back if you need to avoid bending at the hip more than 90°. • When traveling, make frequent stops and get out and walk around.

Getting Out of Car • Push the seat all the way back. • Recline the seat all the way back. • Lift your legs out. Lean back if you need to avoid bending at the hip more than 90°. Place the walker up in front of you and stand up on the unaffected leg.

32 The Center for Bone and Joint Health at Hunterdon Medical Center Planning Your Discharge

Planning for Discharge Most patients go home after discharge from the hospital to continue with therapy in another setting. These are the three paths you can take: 1. Go home and have Physical Therapy in an outpatient facility 1 to 3 times a week. 2. Go home and have a Physical Therapist come to your home 1 to 3 times a week because you are homebound and unable to get out of your home easily. This generally lasts about 2 weeks. 3. Go to a rehabilitation facility for a short in-patient stay because you need a higher level of assistance. When you are discharged from the rehab facility they will arrange for you to have home care or outpatient PT.

The Joint Care Coordinator, Physical and Occupational therapists, Nurses and your Surgeon will help you and your family decide what is best for you.

Home Health Care Services • Therapy and nursing will come to your home to provide care for you. • You will see a physical therapist 1 to 3 times a week. On the days you are not seeing a therapist you will have a home exercise program to do on your own. • They will come for a limited time based on your progress. Your Home Health therapist will advise you when and if you need further therapy in the outpatient setting.

Outpatient Therapy • When it is recommended, you will go to the outpatient therapy setting for your appointments. • The therapy provided in this setting is more advanced. There are machines and equipment to help you become stronger and improve mobility. • You will see a physical therapist 1 to 3 times a week and they will let you know when you no longer need therapy.

Outpatient Physical Therapy Locations Hunterdon Medical Center has several locations for outpatient therapy, which are easily ac- cessed, have knowledgeable therapists and offer convenient hours. Physical Therapy at Physical Therapy at Clinton Health Campus Hunterdon Health and Wellness Center 908-735-3930 908-534-1320 1738 Route 31N, Suite 103 537 Route 22 East Clinton NJ Whitehouse Station, NJ

The Center for Bone and Joint Health at Hunterdon Medical Center 33 Planning Your Discharge

Outpatient Physical Therapy Locations Continued Hunterdon Sports Physical and Occupational Hunterdon Physical and Physical Therapy Therapy at Wescott Therapy and Wellness 908-237-7096 908-788-6394 609-397-9390 222 Route 31N 8100 Wescott Drive, Suite 103 333 North Main Street Flemington, NJ Flemington, NJ Lambertville, NJ

Hawk Pointe Medical Physical and Occupational Office Building Therapy at Bridgewater 908-237-4141 908-237-4109 6 Clubhouse Drive, Suite 103 1121 Route 22W, Suite 207 Washington, NJ Bridgewater, NJ

Sub-acute and Acute Rehabilitation Facilities Some patients will go to Rehab at another care facility before going home. We contact your insurance company to obtain authorization. In general, authorization is based on your level of mobility and need for daily supervised Physical Therapy.

At discharge from the rehab facility, you can continue on your course of recovery with Home Care or Outpatient therapy.

If you will be transferred to a rehab facility, the Social Worker will discuss transportation options available to get you to the facility.

Getting Home – You’re discharged! At discharge, the nurses will fill out your discharge instructions. They will include the following: • The medications you need to take • Signs and symptoms to report to the doctor which are also listed in the following pages • The name and phone number of the home-care agency if you will have home care • The name and appointment time for outpatient therapy, if that is your plan

The best vehicle for transport is a 4-door sedan or average sized SUV.

34 The Center for Bone and Joint Health at Hunterdon Medical Center Your Road to Recovery

Wound Care and Preventing Infections • Most patients will have an AquaCel Dressing in place over their incision. – This dressing is water-proof and can be worn in the shower and pat dry. – It is intended to protect your incision from bacteria that can cause infection. – It is not to be lifted up until it is being removed because it will not re-stick to your skin. – It should be left in place for ONE WEEK or until the day your staples are removed if longer than one week. – If it needs to be removed for any reason before that time, you may cover your incision with a clean, dry gauze. • It is normal to feel some numbness around your incision. • Be aware of the signs of infection and notify your surgeon if you develop any of the following: – Redness in the area around the incision. – A fever higher than 101˚ taken orally under your tongue. – Drainage that looks like pus or smells bad or any discharge that has changed in color or odor. – Increased pain with both activity and rest that is not controlled by pain medications • Your staples will be removed in one of the following ways. – You will reurn to the surgeon’s office at the appointment time they scheduled for you. – By the home care nurse if you are receiving home care. – By the staff in the rehabilitation facility you went to after the hospital.

Long Term Prevention of Infections of Your joint Replacement An infection of your joint replacement is very rare, but it can be very serious. We want to do everything we can to avoid infections whenever possible. When you have joint replacement, an infection can occur in your new joint at any time, but is most common in the first two years after surgery.

Bacteria that can cause an infection can enter your body from different places in your body and spread throughout your bloodstream. They can come from any of the following: • Normal daily activities. • An infection somewhere else in the body. • A procedure which introduces bacteria into the bloodstream including (dental work, colonoscopy, cystoscopy, abdominal surgery, etc).

The Center for Bone and Joint Health at Hunterdon Medical Center 35 Your Road to Recovery

When bacteria enter the bloodstream, on rare occasions, the bacteria can attach to your joint replacement and can cause an infection of the joint replacement and the surrounding joint tissue.

What can you do to protect yourself from infections? • Be aware of and to treat any infection you have anywhere in your body. • If you have any suspicion of an infection (ingrown toe nail, bronchitis, urine infection, etc.) be sure to see your doctor immediately so that you can get diagnosed and treated with antibiotics promptly if needed.

Future Dental or Surgical Procedures Should you take antibiotics prior to certain invasive procedures to prevent infections in your joint replacement?

These are the guidelines recommended in the 2012 American Academy of Orthopaedic Surgeons-American Dental Association Clinical Practice Guideline and a 2014 International Consensus Meeting of Prosthetic Joint Infection: 1. Most Urologists feel strongly that antibiotics should be given prior to urological procedures. 2. For gastrointestinal procedures like endoscopy or colonoscopy, antibiotics should only be given for high-risk patients. 3. For dental procedures, anabiotics should only be given for high-risk patients. 4. High-risk patients include those with the following conditions: a) Auto-immune diseases such as Rheumatoid Arthritis b) Immune suppression from medications, HIV, or other reasons c) Insulin-dependent diabetes mellitus d) Tobacco users e) Malnourishment f) Hemophilia g) Malignancy (Cancer) 5. The reason that prophylactic (prevention) antibiotics are not given routinely to healthy patients prior to these procedures is that anabiotic usage can cause side effects, which at times can be serious. So routine over-use of antibiotics should be avoided if not necessary.

36 The Center for Bone and Joint Health at Hunterdon Medical Center Your Road to Recovery

Managing Your Medications Routine Medications: • Continue your medications at home as prescribed by your surgeon and your prescribing physician. • If you have any questions, please call the physician who prescribed the specific medication to discuss.

Pain Medications: • If pain is mild, you may take acetaminophen (Tylenol). Do not take NSAIDs such as Motrin, Advil, Aleve, Nuprin, etc. unless approved by your surgeon. • Only take Aspirin, Celebrex or Mobic if your surgeon ordered it for you. • Take pain medication as prescribed and needed for pain. • Pain pills take 30-45 minutes to work. Do not wait until pain is severe. • If your medication is not effective in relieving your pain, or you experience unpleasant side effects, do not hesitate to call your surgeon.

Bowel Regularity • Eat a diet high in fiber. • Drink plenty of fluids. • Being active is important for bowel function. • Pain medications with narcotics can slow bowel function. • Stool softeners and laxatives can be used as directed. • If you experience abdominal pain that is severe or your bowels do not move within 3 days, contact your Primary Care physician.

Therapy • Once home, continue with the exercises you learned in the pre-operative class because you may not see the therapist from Home Care or Outpatient Therapy for a few days. • Practice walking as normally as possible WITH THE USE OF AN ASSISTIVE DEVICE (walker, crutches, cane). • Walking is the best exercise you can do for yourself. • Begin by walking for 3-5 minutes every 2-3 hours throughout the day. Gradually increase the frequency until you are walking 3-5 minutes every hour. • Slowly extend the length of time you are walking. • After your walk, you should apply ice and elevate your leg to decrease swelling.

The Center for Bone and Joint Health at Hunterdon Medical Center 37 Your Road to Recovery

Daily Activities Fall Prevention To reduce the risk of falls: • Wear non-skid shoes and use your assistive device when walking. • As you progress, walking on uneven surfaces, such as grass or gravel, may require the use of an assistive device even after you no longer use one indoors. • Maintain proper lighting. • Know where your pets are any time you are walking. • Use adaptive equipment for ease and safety with activities.

In the kitchen: • Have prepared meals available for reheating. • Plan easy meals that do not require a lot of time or effort. • Arrange the kitchen/refrigerator to avoid bending down to reach items. • Have a chair handy as you may tire easily. • Arrange work space for convenience. • Slide objects or use a utility cart to move objects. • Plan menus and make a shopping list.

In the bathroom: • Re-survey the bathroom for safety and ability to maneuver. • Use an elevated toilet seat over the commode to avoid having to sit too deep. • Use the shower (not bath) if your AquaCel D ressing is in place or if not, your wound is dry and there is no drainage. • Avoid scrubbing your incision and pat dry with a towel. • A shower chair or tub bench may be purchased to allow you to sit. • Use a long-handled sponge to reach your feet. • A rubber mat or strips in the shower or tub will help reduce the risk of falls. • Avoid bath oils in the tub or shower. • Handheld shower heads may be helpful.

Around the house: • Arrange for assistance with larger household chores (vacuuming, sweeping, mopping, and laundry). • No heavy lifting for 6-8 weeks

38 The Center for Bone and Joint Health at Hunterdon Medical Center Blood Clot Prevention After Joint Replacement

A blood clot (Deep Vein Thrombosis or DVT) can occur during the first several weeks after sur- gery. It commonly occurs in the calf or thigh. There is a risk of this clot traveling to other parts of your body, such as the lungs. This is known as a pulmonary embolus or PE.

To Reduce the Risk of Blood Clots When You are Discharged: • Continue perform the foot pump exercises throughout the day when you are at rest in a chair. • Be mobile. Do not sit for long periods of time (greater than one hour while you are awake during the day) • Take any medications you have been prescribed as blood thinners.

The Center for Bone and Joint Health at Hunterdon Medical Center 39 Blood Thinning Medications

Most patients will be prescribed a medication to thin the blood for 4 weeks after surgery. If you currently take a medication to thin your blood, your surgeon and the physician who prescribes the blood thinner for you will tell you what you need to take to restart your medication after surgery.

If you do not take medication to thin your blood before you have surgery, in most cases either Aspirin or Coumadin will be prescribed after surgery.

Aspirin • Enteric coated Aspirin 325 mg is recommended as it has a coating on it that protects your stomach and may prevent the irritation some people experience. • Take the amount of tablets per day that were prescribed for you. DO NOT TAKE MORE THAN WHAT WAS PRESCRIBED. You are taking Aspirin to thin your blood, NOT to control your pain. • Take with food to help limit any stomach upset. • Your can expect bruising on the leg you had surgery on and in any area you bump yourself while you are on Aspirin.

Coumadin • If your surgeon orders Coumadin and you don’t normally take Coumadin, you will be on it for 4 weeks. • Coumadin requires dose adjustments based on your blood work. • You will get education about diet restriction and signs and symptoms of bleeding problems when you are in the hospital. • You will be given directions for lab work and dosing by a member of the healthcare team before you are discharged home.

Warning Signs of Possible Blood Clots in Your Leg Include: • Warmth, swelling, increased pain, tenderness, redness in the thigh, calf, ankle or foot. (Some swelling in the thigh or leg is normal after knee replacement surgery) *Notify your surgeon’s office immediately if you develop any of these signs.

Warning Signs That a Blood Clot has Traveled to Your Lung Include: • Sudden increased shortness of breath • Sudden onset of chest pain • Localized chest pain with coughing *Seek medical treatment immediately if these symptoms occur.

40 The Center for Bone and Joint Health at Hunterdon Medical Center Long-term Care of Your Hip Replacement

Returning to Everyday Life Driving: • Talk with your surgeon on the follow-up appointment about your readiness to safely drive. Usually it takes about 6 weeks. • In general, you should not drive when you are taking narcotics or if you have pain when you press on the accelerator or brake pedal. • The decision to drive will be based on these factors and your judgment.

Travel: For the first three months: • Do not sit in one position for long periods of time. • On car trips, stop every 1-2 hours to stretch your legs. • Foot pumps will help circulation and reduce pain and swelling. • On a plane ride, get up and stretch your legs every hour.

Lifetime considerations: • Your new joint may activate metal detectors required for security in airports or other building. Tell the security agent about your hip replacement.

Sexual Activity • Talk to your surgeon about when you can safely resume sexual intercourse, generally 4-6 weeks after surgery. • This allows for the incision and muscles around the hip replacement to heal and you to function with limited amount of pain. • It is important that you communicate with your partner about your hip replacement and the limitations that you may have, such as bending the knee or precautions for the hip.

The Center for Bone and Joint Health at Hunterdon Medical Center 41 Pre- and Post-op Exercises

Exercise within the limits of your pain. Stop if you feel sharp, stabbing, or unusual pain. The goal is to complete 3 sets of 10 repetitions and to perform these sets 3-4 times a day.

Ankle Pumps – Bend your ankles up and down.

Quad Sets – (Knee pushdowns) Press your knee down so Gluteal Sets – Squeeze your gluteal muscles (buttock) you are tightening the muscle on the front of your together and hold for 5 seconds. thigh and hold for 5 seconds.

42 The Center for Bone and Joint Health at Hunterdon Medical Center Pre- and Post-op Exercises

Heel Slides – While lying down, slide heel up, bending your knee and keeping your heel on the bed.

Straight Leg Raises – While lying, bend your unaffected leg, keeping your foot flat. Lift your affected leg keeping your knee straight and toes pointed towards your head.

The Center for Bone and Joint Health at Hunterdon Medical Center 43 Pre- and Post-op Exercises

Abduction-Adduction slides – Lie down with toes pointed up and knees straight. Tighten your thigh muscle and slide your leg out to the side and back to the starting position.

Arm Chair Push Ups – Sit in a sturdy armchair with feet flat on the floor and your hands on the armrests. Straighten your arms and lift your bottom up from the seat as far as you can using your legs as needed to help.

44 The Center for Bone and Joint Health at Hunterdon Medical Center Pre- and Post-op Exercises

Heel Raises – Stand straight with a firm hold on a stable object like a chair or counter top. Raise yourself up on your toes and then back on your heels.

Knee Flexion – Stand straight with a firm hold on a stable object like a chair or counter top. Lift your heel by bending at your knee.

The Center for Bone and Joint Health at Hunterdon Medical Center 45 Pre- and Post-op Exercises

Abduction Leg Raises – Stand straight holding on to a stable object like a chair or counter top with your legs slightly apart. Lift your leg to the side and hold for 5 seconds.

46 The Center for Bone and Joint Health at Hunterdon Medical Center Our Physicians

Expertise Faculty Appointments Spine,Total Joints,Arthroscopy of the Knee Hunterdon Medical Center Education • Anterior Cervical Discectomy College: Seton Hall University, • Lumbar and Cervical Fusions South Orange, NJ Cum Laude • Kyphoplasty for Vetebral Medical School: New Jersey Medical Compression Fractures School, UMDNJ, Newark, NJ • Laminectomy Residency: Monmouth Medical Center, • Epidural and Lower Back Injections Hershey Medical Center, Pediatrics • Minimally Invasive Lumbar Surgery Fellowships: Spine Surgery, University • Outpatient Percutaneous Discectomy of Iowa Hospital, Iowa City, IA • IDET (Intradiscal Electrothermal Therapy) Board Certification • X-Stop Spacer Patrick M. Collalto American Board of Orthopedic Surgeons • Microdiscectomy Memberships • Fellow, American Academy of Orthopedic Surgeons • North American Spine Society • Hunterdon County Medical Society, Past President • New Jersey Medical Society • New Jersey Orthopedic Society, Board Member

Expertise Board Certifications Sports Medicine and Joint Replacement, • American Board of Orthopaedic Surgery Orthopedic Consultant – Hunterdon • Subspecialty Certification – County High Schools Sports Medicine Education Memberships High School: Valedictorian • Fellow, American Academy of College: University of California, Irvine Orthopedic Surgeons Summa Cum LaudePhi Beta Kappa • American Orthopedic Society for Medical School: University of California, Sports Medicine Los Angeles (UCLA) • American Association of Hip and Residency: University of California, Knee Surgeons Los Angeles (UCLA) • The Academy of Medicine of New Jersey Robert C. More Fellowships: • New Jersey Orthopedic Society • Sports Medicine – UCSD • American Medical Association • Joint Replacement – UCLA Academic Appointment Advanced Training: Clinical Assistant Professor, New Jersey • Hip Arthroscopy, University of Pittsburgh Medical School/UMDNJ • Autogenous Chondrocyte Implantation

The Center for Bone and Joint Health at Hunterdon Medical Center 47 Our Physicians

Expertise Board Certification Sports Medicine, Knee and Shoulder • American Board of Orthopedic Replacement, Surgery of the Shoulder, Surgeons, 2005 Surgery of the Knee, Arthroscopic and • Subspecialty Certification – Minimally Invasive Procedures, Consultant – Sports Medicine, 2008 Hunterdon County High Schools Memberships Education • Fellow, American Academy of College: University of Pennsylvania, Orthopedic Surgeons Philadelphia, PA • Arthroscopy Association of Medical School: Jefferson Medical College, North America Philadelphia, PA • New Jersey Orthopedic Society Residency: • Medical Society of the State of Michael E. Pollack • St. Luke's – Roosevelt Hospital Center, New Jersey University Hospital, Columbia • American Medical Association University, New York, NY • Hunterdon County Medical Society, Fellowships: Shoulder,Knee and Arthroscopic Past President Surgery, California Pacific Medical Center, Faculty Appointments San Francisco, CA Hunterdon Medical Center

Expertise Fellowships: Hip and Knee Arthroplasty, Unicondylar Knee Replacement, Hip Massachusetts General Hospital, Boston, MA Resurfacing, Complex Hip and Knee Board Certification Reconstruction, Primary and Revision Hip American Board of Orthopedic Surgeons Arthroplasty, Primary and Revision Knee Memberships Arthroplasty, Arthroscopy of the Hip and American Academy of Orthopedic Surgeons Knee, General Orthopedics Hunterdon County Medical Society New Education: Jersey Orthopedic Society Medical Society College: Tufts University, Magna Cum of the State of New Jersey Laude, Boston, MA Facility Appointments Medical School: UMDNJ – New Jersey Hunterdon Medical Center Medical School, Newark, NJ Philip J. Glassner Residency: NYU Hospital for Joint Diseases, New York, NY

48 The Center for Bone and Joint Health at Hunterdon Medical Center Our Physicians

Expertise Board Certification Spine Surgery, Adult Hip and Knee American Board of Orthopedic Surgery Reconstruction, General Orthopedics Memberships Education • Fellow, American Academy of College: Boston College, Chestnut Hill, Orthopedic Surgeons MA • North American Spine Society Bachelor of Science in Biology, • Jefferson Orthopedic Society Magna Cum Laude • American Medical Association Medical School: State University of New • American Academy of Hip and York at Stony Brook, NY, MD with Knee Surgeons Distinction in Research, May 1995 • Hunterdon County Medical Society Residency: Thomas Jefferson University Faculty Appointment Thomas A. St. John Hospital, Philadelphia, PA Hunterdon Medical Center Fellowships: Adult Reconstruction and Spine Surgery, Thomas Jefferson University Hospital, Philadelphia, PA

Expertise Board Certification Total Knee Replacement, Partial Knee American Board of Orthopaedic Surgeons, Replacement, Total Hip Replacement, 2013 Certified SuperPATH Hip Surgeon & Trainer Memberships Education • Fellow, American Academy of College: Cornell University, Ithaca, NY Orthopaedic Surgeons (AAOS) Bachelor of Science in Biology, Magna Cum • Member, American Association of Hip Laude and Knee Surgeons (AAHKS) Medical School: Cornell Medical College, • Member, International Society for New York, NY Technology in Arthroplasty (ISTA) Residency: New York Orthopaedic • Alpha Omega Alpha (AOA) Hospital, Columbia University Presbyterian Faculty Appointment Eric M. Gordon Hospital, New York, NY Hunterdon Medical Center Fellowships: Adult Reconstruction, lnsall Scott Kelly Institute Lenox Hill Hospital, New York, NY

The Center for Bone and Joint Health at Hunterdon Medical Center 49 Resources

Outpatient Physical Therapy Call to make or confirm an appointment. Physical Therapy at Hunterdon Sports and Hawk Pointe Medical Physical and Clinton Health Campus Physical Therapy Office Building Occupational Therapy 908-735-3930 908-237-7096 908-237-4141 at Bridgewater 1738 Route 31N 222 Route 31N 6 Clubhouse Drive 908-237-4109 Suite 103 Flemington, NJ Suite 103 1121 Route 22W Clinton, NJ Washington, NJ Suite 207 Physical and Bridgewater, NJ Physical Therapy at Occupational Therapy Hunterdon Physical Hunterdon Health and at Wescott Therapy and Wellness Wellness Center 908-788-6394 609-397-9390 908-534-1320 8100 Wescott Drive 333 North Main Street 537 Route 22 East Suite 103 Lambertville, NJ Whitehouse Station, NJ Flemington, NJ Information to Help You Quit Tobacco Contact your primary care physician to discuss treatment options that are safe for you. Remember to keep all of your doctors informed before you begin any type of medication to help quit tobacco. On-line and Phone Support Smoking Quitline: Programs New Jersey Quitline: 1-877-44U-QUIT (1-877-448-7848) Hunterdon Prevention Resources 866-657-8677 or Talk with a tobacco cessation 908-782-3909 www.njquitline.org counselor for help quitting and get On-site Certified Tobacco Treatment Eligibility and services fluctuate. answers to your smoking-related Specialist & Prevention Educator. Free, available in 26 languages and questions in English or Spanish. 4 Walter Foran Boulevard, Suite 410, confidential. Telephone counseling Toll free within the United States. Flemington, NJ 08822 service for tobacco users who are Available Monday thru Friday from Service includes: Six weeks of 1:1 ready to stop. Call today and speak 8:00 am – 8:00 p.m. education, help creating a personal with your own trained quit coach. quit p lan, instructions for proper No matter which method you choose, Plan My Quit (Pfizer): nicotine replacement therapies, the Quitline can more than double www.planmyquit.com medication options & counseling your chances for success! Free A video program led by a Tobacco with follow-up (3 months, 6 months Treatment Specialist and former and 1 year). Will work with your Smokefree.gov: smoker who coaches you on develop- Primary Care Physician to discuss www.smokefree.gov/ or ing an effective quit plan. Plan-to-Quit treatment options. Call to discuss www.espanol.smokefree.gov/ cards are available at no cost and in- costs and insurance coverage. (Spanish). Information and profes- clude powerful activities to help you sional assistance available to help you jump-start your quit and keep you on become and remain a non-smoker. track to staying tobacco free. Offers a step-by-step quit smoking guide with interactive tools and Smoking and Tobacco Use resources. You can also get (Centers for Disease Control “Smokefree TXT”, a mobile service and Prevention): that provides 24/7 encouragement, www.cdc.gov/tobacco advice and tips to help you stop Information, quit tips and a variety smoking for good. (Fees may apply) of resources. 50 The Center for Bone and Joint Health at Hunterdon Medical Center

OUTPATIENT PHYSICAL THERAPY LOCATIONS

Physical Therapy at Hunterdon Sports Hawk Pointe Medical Office Clinton Health Campus and Physical Therapy Building 1738 Route 31N 222 Route 31N 6 Clubhouse Drive Suite 103 Flemington, NJ 08822 Suite 103 Clinton, NJ 08809 Phone: 908-237-7096 Washington, NJ 07882 Phone: 908-735-3930 Phone: 908-237-4141

Physical Therapy at Hunterdon Physical and Occupational Physical and Occupational Health and Wellness Center Therapy at Wescott Therapy at Bridgewater 537 Route 22 East 8100 Wescott Drive 1121 Route 22W Whitehouse Station, NJ 08889 Suite 103 Suite 207 Phone: 908-534-1320 Flemington, NJ 08822 Bridgewater, NJ 08807 Phone: 908-788-6394 Phone: 908-237-4109

Hunterdon Physical Therapy and Wellness 333 North Main Street Lambertville, NJ 08530 Phone: 609-397-9390

Visit us at www.hunterdonhealthcare.org